Machine-learning based query construction and pattern identification for hereditary angioedema

ABSTRACT

A method, computer program product, and system identifying a probability of a medical condition in a patient. The method includes a processor obtaining data set(s) related to a patient population diagnosed with a medical condition and based on a frequency of features in the data set(s), identifying common features and weighting the common features based on frequency of occurrence in the data set(s) to generate mutual information. The processor generates pattern(s) including a portion of the common features to generate a machine learning algorithm(s). The processor compiles a training set of data to use to tune the machine learning algorithm(s). The processor dynamically adjusts common features in the pattern(s) such that the machine learning algorithm(s) can distinguish patient data indicating the medical condition from patient data not indicating the medical condition. The processor applies the machine learning algorithm(s) to data related to the undiagnosed patient, to determine the probability.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. Non-Provisional Ser. No.15/724,480, filed Oct. 4, 2017, entitled, “MACHINE-LEARNING BASED QUERYCONSTRUCTION PATTERN AND IDENTIFICATION FOR HEREDITARY ANGIOEDEMA” whichclaims priority to U.S. Provisional Application No. 62/404,338 filedOct. 5, 2016, entitled, “MACHINE-LEARNING BASED QUERY CONSTRUCTION ANDPATTERN IDENTIFICATION” which is incorporated herein by reference in itsentirety.

FIELD OF INVENTION

The invention relates to the creation and utilization of machine-basedlearning algorithms to establish and identify data patterns in theabsence of established knowledge regarding these patterns.

BACKGROUND OF INVENTION

Health patterns indicative of certain health conditions are oftendifficult to identify. This is true for diseases and medical conditionsthat are readily known to the general population, as well as withdiseases that are so rare that they affect only a small portion of thepopulation.

Some diseases, although known to the general public, are clinicallydiagnosed through exclusion. Thus, a diagnosis of the disease can bedelayed as each other possibility is systematically excluded. Thisprolonged diagnostic time can be detrimental as it delays initiatingapproved treatments and the progression of the disease for anundiagnosed patient may preclude that patient, when finally diagnosed,from enrolling in a clinical trial and/or a given therapy not having anyeffect, since the disease may have progressed to a state where thetherapy is no longer effective.

A disease is defined as rare (orphan) if it affects fewer than 200,000people in the US; there are about 7,000 types of such rare disorders.Most of these diseases are genetic, frequently misdiagnosed for years,and without FDA-approved drug treatment. Timely discovery ofmisdiagnosed and underdiagnosed patients is crucial for their survivaland for the proper development and delivery of the right therapeutics(including niche drugs developed by pharmaceutical companiesspecifically for these rare conditions). The problem of findingpotentially undiagnosed subjects for orphan diseases is that activesurveillance for such conditions (canvassing a segment of populationwith questionnaires and/or tests) is expensive and impractical for rare(or even not so rare) diseases, and passive surveillance has to rely onexisting medical records (produced by hospitals and insurancecompanies), which may be incomplete, unreliable, and not contain enoughinformation relevant for the predictive diagnostics. Challenges inidentifying these orphan diseases from population-related data existbased on both the limitations of present computing solutions to processthe volume of data efficiently and the lack of knowledge regarding whatparameters should be searched within this large volume.

One disease that is challenging to diagnose is Hereditary Angioedema(HAE). HAE is a rare genetic condition whose symptoms include swellingin various parts of the body. HAE disease course is episodic in naturewith aperiodic episodes. After each episode, the patient recovers fullywith no traces left behind. Patients are asymptomatic both before andafter attacks and/or episodes of the disease. However, during attacks,patients often suffer excruciating abdominal pain, nausea, and vomitingcaused by swelling in the intestinal wall. Swelling of the airway orthroat is particularly dangerous, because it can cause death byasphyxiation. Presently, there is a diagnostic test for the disease, butbecause HAE it is typically misdiagnosed, it is not typically requestedby the provider for years prior to diagnosis. The average time todiagnose HAE is seven years and is commonly misdiagnosed as allergicreactions HAE occurs in the US population at a rate ranging from 1 in10,000 to 1 in 50,000 people.

The challenges related to establishing patterns that identify an eventin a large volume of data and actually identifying that event in thislarge volume are not unique to disease or to orphan diseaseidentification.

SUMMARY OF INVENTION

Shortcomings of the prior art are also overcome and additionaladvantages are provided through the provision of a method determining aprobability of the presence of a given medical condition based on a dataset related to a patient, the method includes: obtaining, by one or moreprocessors in a distributed computing environment, one or moremachine-readable data sets related to a patient population from one ormore databases; identifying, by the one or more processors, based on aninitial patient definition, a portion of data from the machine-readabledata sets related to a patient population, wherein the portion of thedata comprises patients of the patient population with a medicalcondition; based on a frequency of features in the portion of the data,identifying, by the one or more processors, common features in theportion of the data and weighting the common features based on frequencyof occurrence in the portion of the data, wherein the common featurescomprise mutual information; generating, by the one or more processors,one or more patterns comprising a portion of the common features;generating, by the one or more processors, one or more machine learningalgorithms based on the one or more patterns, the one or more machinelearning algorithms to identify presence or absence of the given medicalcondition in an undiagnosed patient based on absence or presence offeatures comprising the one or more patterns in data related to theundiagnosed patient; utilizing, by the one or more processors,statistical sampling to compile a training set of data, wherein thetraining set comprises data from the one or more data sets and at leastone additional data set comprising data related to a population withoutthe medical condition, and wherein utilizing the statistical samplingcomprises formulating and obtaining queries based on the data set andprocessing and responding to the queries, the processing comprising, foreach query: evaluating, by the one or more processors, the query todetermine one of a high or a low level of anticipated complexity of aprospective response to the query; based on the query being evaluated ata low level of anticipated complexity, assigning, by the one or moreprocessors, the query to a computing resource in the distributedcomputing environment, wherein the computing resource is configured torespond to low level complexity queries; and based on the query beingevaluated at a high level of anticipated complexity, distributing, bythe one or more processors, the query over a group of computingresources of the distributed computing environment to maximizeefficiency, wherein the distributing comprises assigning each computingresource of the group of computing resources a portion of the query toexecute in parallel with at least one other computing resource of thegroup of computing resources executing another portion of the query;tuning, by the one or more processors, the one or more machine learningalgorithms by applying the one or more machine learning algorithms tothe training set of data; dynamically adjusting, by the one or moreprocessors, the common features comprising the one or more patterns toimprove accuracy such that the one or more machine learning algorithmscan distinguish patient data indicating the medical condition frompatient data that does not indicate the medical condition; anddetermining, by the one or more processors, based on applying the one ormore machine learning algorithms to data related to the undiagnosedpatient, a probability, wherein the probability is a numerical valueindicating a percentage of commonality between the data related to theundiagnosed patient and the one or more patterns.

Computer systems, computer program products, and methods relating to oneor more aspects of the technique are also described and may be claimedherein. Further, services relating to one or more aspects of thetechnique are also described and may be claimed herein.

Additional features are realized through the techniques of the presentinvention. Other embodiments and aspects of the invention are describedin detail herein and are considered a part of the claimed invention.

BRIEF DESCRIPTION OF DRAWINGS

One or more aspects of the present invention are particularly pointedout and distinctly claimed as examples in the claims at the conclusionof the specification. The foregoing and objects, features, andadvantages of one or more aspects of the invention are apparent from thefollowing detailed description taken in conjunction with theaccompanying drawings.

FIG. 1 depicts a workflow associated with aspects of embodiments of thepresent invention.

FIG. 2 depicts a workflow associated with aspects of embodiments of thepresent invention.

FIG. 3 depicts a workflow associated with aspects of embodiments of thepresent invention.

FIG. 4 depicts one example of aspects of a computing environment used toexecute one or more aspects of an embodiment of the present invention.

FIG. 5 depicts one example of aspects of a computing environment used toexecute one or more aspects of an embodiment of the present invention.

FIG. 6 depicts one example of aspects of a computing environment used toexecute one or more aspects of an embodiment of the present invention.

FIG. 7 depicts a workflow associated with aspects of embodiments of thepresent invention.

FIG. 8 depicts one example of aspects of a computing environment used toexecute one or more aspects of an embodiment of the present invention.

FIG. 9 illustrates certain aspects of some embodiments of the presentinvention.

FIG. 10 depicts a distribution of potential Hereditary Angioedema (HAE)patients within metropolitan statistical areas as determined by certainaspects of some embodiments of the present invention.

FIG. 11 depicts one embodiment of a single processor computingenvironment, which may comprise a node of a cloud computing environment,to incorporate and use one or more aspects of the present invention.

FIG. 12 depicts one embodiment of a computer program productincorporating one or more aspects of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

Aspects of the present invention and certain features, advantages, anddetails thereof, are explained more fully below with reference to thenon-limiting examples illustrated in the accompanying drawings.Descriptions of well-known materials, fabrication tools, processingtechniques, etc., are omitted so as not to unnecessarily obscure theinvention in detail. It should be understood, however, that the detaileddescription and the specific examples, while indicating aspects of theinvention, are given by way of illustration only, and not by way oflimitation. Various substitutions, modifications, additions, and/orarrangements, within the spirit and/or scope of the underlying inventiveconcepts will be apparent to those skilled in the art from thisdisclosure. The terms software, program code, and one or more programsare used interchangeably throughout this application.

The term “diagnose” is utilized throughout the application in to suggestthat a data model that is generated and method determining a probabilityof the presence of a given physical or medical condition, including butnot limited to a disease or an orphan disease, based on a data setrelated to an individual, referred to herein as a patient. However, theso-called diagnosis provided by aspects of embodiments of the presentinvention is not analogous to a medical diagnosis, provided by a healthprofessional, often based on the result of a medical test or procedure.Rather, a diagnosis herein can be understood as a recognition of apattern, or a given portion of a pattern, where the pattern wasgenerated as described herein, in embodiments of the present invention.With the specific example of HAE, which is discussed throughout, thereis a clinical test that a healthcare provider can utilize to determinewhether an individual has HAE. However, the disease is so oftenmisdiagnosed that the test is rarely ordered. Embodiments of the presentinvention identify previously undiagnosed individuals who may fit amodel for the disease that is generated by one or more programs in anembodiment of the present invention. Thus, once identified by the one ormore programs in an embodiment of the present invention, a healthcareprovider can order the test. Utilizing the test would result in adefinitive medical diagnosis. As seen in particular with this example,the one or more programs in an embodiments of the present inventiongenerate a likelihood, while it is a definitive medical test, not theone or more programs, which provide a diagnosis.

Embodiments of the present invention combine data analytics and patternprediction to enable program code executing on at least one processor toidentify patterns within a data set in the absence of advance datadefining the pattern. In an embodiment of the present invention, programcode analyzes a data set to identify parameters comprising data pointscharacteristic of a certain condition (e.g., a physical condition, adisease, HAE, etc.). The program code adapts a machine learningalgorithm to utilize these parameters to identify data consistent withthis condition and by utilizing data sets of sizes which cannot beanalyzed by a human or by a computing environment that does notadequately distribute processing tasks related to the analysis. Theprogram code identifies these parameters in the absence of establisheddata characterizing the condition. This approach can be utilized todetermine recognition patterns to identify diseases (e.g., HAE),including orphan diseases, in a data set that includes data related toindividuals with this condition and subsequently, to identify thesepatterns in an unlimited data set, where the prevalence of individualswith this condition is unknown. However, this approach is not merelylimited to physical condition (e.g., disease) identification, but can beutilized in general to predict criteria identifying an event and applythese criteria across a data set that is not constrained by size orcomplexity. Throughout this specification, aspects of embodiments of thepresent invention are applied to the task of physical (or medical)condition (e.g., disease) identification, and specifically, to theidentification of HAE. However, this singular (non-limiting) applicationof aspects of embodiments of the present invention is offered toillustrate the functionality of the present invention, as understood byone of skill in the art.

Advantages provided by aspects of some embodiments of the presentinvention include: (1) the ability to identify features thatdifferentiate individuals with certain medical conditions (e.g., HAE)from the general population, prior to these individuals receiving aformal diagnosis of the medical condition, (2) the ability to determinepotential predictors of a future formal diagnosis of a medical condition(e.g., HAE), (3) the ability to demonstrate the appearance of symptomsof the medical condition (e.g., HAE) earlier than currently understoodby the medical community, and (4) the ability to provide the potentialto accelerate clinical diagnosis of the medical condition (e.g., HAE).In the case where HAE is the condition for which the one or moreprograms in an embodiment of the present invention generates a model andutilizes the model to identify individuals with a certain probability offuture diagnosis, embodiments of the present invention include thefollowing aspects: (1) one or more programs may diagnose patients, onaverage, approximately 9 to approximately 15 months earlier (with anaverage of approximately 12 months earlier (than using traditionalmethods), (2) one or more program may increase the “hit rate” foridentifying an individual who is later diagnosed with HAE from 1:10,000to 1:13, and (3) the one or more programs may geo-locate undiagnosed HAEpatients.

The approximate range of 9 to 15 months (averaging 12) is a significantimprovement over existing methods of determining whether to implement atest on a patient for HAE that would result in a definitive diagnosis.Using existing techniques, HAE takes a long time from diagnosis toappropriate treatment, generally 8 years. During the 8 years without adiagnosis a patient may frequently visit emergency departments (EDs), beadmitted for hospital stays, and often receive inappropriate andexpensive procedures. Earlier diagnosis and treatment, which is madepossible through the probability determined by program code inembodiments of the present invention, removes patients from the cycle ofhigh-cost, ineffective treatment that drives them back for more of thesame, thus reducing waste and improving patient outcomes. It isestimated that there are approximately 3.2 million potential patientswith rare diseases in the United States. Thus, by applying predictiveanalytics to claims databases, the one or more programs identifypotential patients with HAE (and other diseases), opening the door forpayers to help physicians maximize outcomes and value in the care ofthese patients.

Certain embodiments of the present invention represent improvements overknown methods of data identification, both in the application ofidentifying individuals with physical/medical conditions, such as HAE,as well as in data management and data mining in general. For example,embodiments of the present invention enable the determination andidentification of patterns based on an unlimited number of factors,given the ability of the program code to mine large data stores. Forexample, when applied to creating a profile (e.g., a disease or medicalcondition profile) and identifying individuals that fit this profile,relevant features that the program code builds into a pattern for lateridentification of individuals that fit this pattern are not solely basedon diseases, but on drugs and procedures as well, which expands theinformation content that can be leveraged by the overall process.Embodiments of the present invention increase computational efficiencybecause, when building a profile to identify a given quality, theprogram code selects relevant features using not just prior knowledgeand frequency count, but ultimate information theory mechanisms,including mutual information, and weight the variety of informationutilized by, for example, truncating a the set of obtained features toestablish a level of significance for each identified feature in themutual information.

Mutual information is an example of a method that can be utilized toidentify features in an embodiment of the present invention. Furtherembodiments of the present invention utilize varying techniques toselect features, including but not limited to, diffusion mapping,principal component analysis, recursive feature elimination (a bruteforce approach to selecting features), and/or a Random Forest to selectthe features. Embodiments of the present invention that utilize mutualinformation, diffusion mapping, and a Random Forest may provide certainefficiency advantages.

Aspects of embodiments of the present invention represent improvementsto existing computing technology and are inextricably tied to computing.Specifically, embodiments of the present invention represent improvedmethods of handling large volumes of data and for building logisticalmodels from the data. For example, embodiments of the present inventionreduce the observed data rate in the eventual results because theprogram code preprocesses the data utilized to build a pattern, ratherthan using a less efficient binary binning procedure.

Aspects of embodiments of the present invention are inextricably tied tocomputing at least because the electronic models, including disease ormedical condition models, for conditions such as HAE, generated byembodiments of the present invention cannot be generated outside ofcomputing and do not exist outside of computing. Records initiallyutilized in embodiments of the present invention are electronic recordsin one or more data set, contained in one or more database, that aremachine readable. The resultant models are also electronic and areapplied to additional electronic data sets utilizing computingresources. Because of both the volume and the nature of data, anindividual is not capable of accomplishing the specific aspects ofembodiments of the present invention that result in a machine readabledata model that can be applied by program code to additional data setsin order to identify records with a probability of an event or conditionthat the model was generated to predict the probable presence of.

Embodiments of the present invention provide utility that individualsand existing systems are incapable of because of the speed at which theyare able to provide results. To be useful, program code in embodimentsof the present invention both generates and updates models and providesresults (identification of records that comport with the model), withina limited temporal period. For example, in a scenario where anindividual visits a healthcare provider, the individual and the providerwould benefit from acquiring information regarding whether theindividual, as represented by an electronic medical record, has items inthe record that match the data sought by one or more disease models. Ifthis information cannot be provided within the visit, it is arguably notuseful to the individual or the healthcare provider. Thus, inembodiments of the present invention, the program code analyzes anindividual record and applies disease models in real-time, or close toreal-time. Thus, embodiments of the present invention enable real-timeanalysis of an electronic medical records of a given individual based onwhether the individual's medical records includes one or more patternsdetermined by program code in embodiments of the present invention.

In certain embodiments of the present invention the program codepredicts and detects patterns in data by utilizing Support VectorMachines (SVMs). In an aspect of an embodiment of the present invention,the program code trains a linear SVM classification algorithm forsegregating database entries, for example, to separate entriesrepresenting individuals with a given condition from entriesrepresenting individuals that do not have the condition. In anembodiment of the present invention, the program code utilizes linearSVM, rather than, for example, logistic regression, Random Forest (RF)grouping algorithms, and/or other simple statistical approaches, toachieve a best available classification performance. Another advantageof certain embodiments of the present invention that utilize SVM is thatthe program code can apply the SVM score of the false positive data as amechanism to sort out the most promising subjects. (Certain embodimentsof the present invention do utilize RF grouping algorithms and logisticregression with SVM in order to achieve hyper-parameter optimization.)

Embodiments of the present invention provide advantages and improvementsthat are inextricably tied to computer technology also becauseembodiments of the present invention offer certain advantages thatincrease computational efficiency and efficacy. For example, asdescribed in greater detail later on, embodiments of the presentinvention utilize distributed processing based on anticipated queryresults in order to decrease the timeline for key analytic deliverables.This distributed processing enables the program code to perform multipleanalysis processes simultaneously. Portions of certain embodiments ofthe present invention can be migrated to a cloud architecture and madeavailable to users as software as a service (SaaS) offerings. Theunlimited computational capacity of resources in a cloud architectureare suited to support the program code's distribution of simultaneousqueries and processes in order to meet the efficiency demands of thesystem in a data rich environment.

Embodiments of the present invention also provide advantages andimprovements that are inextricably tied to computer technology becausethey utilize machine learning. One advantageous aspect of someembodiments of the present invention over existing approaches to event(e.g., condition) identification in data dense environments is that someother methods approach the problem of event identification andrecognition as a statistical problem, instead of a machine learning one,which is an approach that limits the options in available tools. Byutilizing machine learning, embodiments of the present invention canidentify records that include an event where the information directlyidentifying the event is absent. For example, by using machine learning,program code can identify patients with a given disease in a data set ofundiagnosed patients, i.e., where the data does not already indicatethat the disease is present in the patient. In some cases, the programcode can utilize machine learning to indicate that an individual isinfected with a disease when the opposite is indicated in data relatedto that individual. Thus, the program code is not merely identifying andretrieving existing established data stored in one or more memorydevice. Rather, the program code establishes a pattern, continuouslytrains a machine learning algorithm to apply the pattern, and utilizesthe algorithm to identify instances of an event not already explicitlyindicated by the data utilizing this pattern.

Embodiments of the present invention provide advantages over knowndiagnostic systems when utilized to determine mutual information andapply this information to an analysis of a data set where the presenceof the event related to the mutual information is unknown, at leastbecause the process is devoid of selection bias. Returning to thedisease example, in embodiments of the present invention, there are noassumptions regarding an individual that are carried into the programcode and the program code performs its analyses consistently. Selectionbias is an issue when attempting to identify a medical condition as amedical professional may be prone to certain conclusions based on, forexample, past experience. Expanding on the disease example, this isissue can be problematic both with orphan diseases as well as fordiseases for which doctors make a medical diagnosis as a result ofeliminating other possibilities. For example, in the area of orphandisease identification, this bias is especially problematic because therarity of an orphan disease means that a medical professional may comeinto contact with very few people, or even no people at all, with agiven condition until a certain patient presents the condition.

As aforementioned, challenges in identifying conditions, includingdiseases, such as HAE and various orphan diseases, frompopulation-related data exist based on both the limitations of presentcomputing solutions to process the volume of data efficiently and thelack of knowledge regarding what parameters should be searched withinthis large volume. In the case of orphan diseases, the small number ofconfirmed cases renders pattern building and recognition challenging,and the case of a disease where a medical diagnosis is the result ofeliminating other possibilities renders the same data problems. In thecase of a disease such as HAE, misdiagnosis is so common that ordering adefinitive test may not be efficient or effective unless there is someuseful information that indicates a probable positive result. Regardingthe volume of data, embodiments of the present invention can process alarge number of patients coded with a large number of universe codes.For example, an embodiment of the present invention can be utilized toprocess the patient histories of more than 180 million patients, whoserecords may include up to 10 years of recorded healthcare history. Giventhe distributed nature of the processing architecture, the number ofpatients that can be processed/scored is only limited by storage, as theefficiency of the process enables the processing of increasingly largevolumes of data.

Workflows of certain embodiments of the present invention can includethree stages: data integration, pattern extraction, and populationseparation. Data integration refers to aspects of embodiments of thepresent invention in which the program code derives discriminatingfeatures of a first data set, where an event is present. For example, ifthe event is a certain orphan disease, or HAE, the program code mayanalyze records of individuals medically diagnosed with the orphandisease or HAE and extract discriminating features that describe thetreatment journey of these patients.

Pattern integration refers to aspects of embodiments of the presentinvention in which the program code develops a pattern for identifyingrecords with a given event based on using the most distinctive featuresextracted during data integration. For example, the program code woulddevelop patterns describing the most distinctive features of the givendisease that the program code extracted from the patient records.

Population separation refers to aspects of embodiments of the presentinvention where the program code utilizes the pattern to identify theevent in one or more data store. For example, returning to the diseaseexample, by analyzing data resources including records identifying largepopulations, the program code identifies within the resources whichpatient clusters match the treatment pathways exhibited by the knownsufferers.

Referring specifically to HAE, in utilizing aspects of embodiments ofthe present invention to build a data model related to HAE and applyingthat dynamic model to identify individuals that fit the model within agiven probability, embodiments of the present invention enableidentification of early HAE by using big data analytics of a largeclaims database. FIG. 1 is a workflow 100 that illustrates aspects ofembodiments of the present invention, including one or more programsthat perform data integration (e.g., patient definition), patternextraction (e.g., feature extraction), and generate populationseparation maps (e.g., prediction).

As will be illustrated and discussed herein, one or more programs,executed by at least one processing resource, mine data utilizingvarious aspects of embodiments of the present invention to identifyfeatures in the electronic medical data of patients who were previouslymedically diagnosed with a given disease. In some embodiments of thepresent invention, one or more programs in some embodiments of thepresent invention specifically mine the electronic claim histories ofthe patients to find factors that differentiate these patients from thegeneral population, even before the patients received the initialdiagnosis of HAE by a medical professional.

In at least one embodiment of the present invention one or more programsin embodiments of the present invention determined diagnostic,procedural, therapeutic, and healthcare provider characteristics thatwere most predictive of a medical diagnosis of HAE. The one or moreprograms determined that the most predictive diagnoses, in weightedorder, include: 1) allergic reactions; 2) swelling, mass, or lump inhead and neck; 3) routine general medical examination at a healthcarefacility; 4) immunizations and screening for infectious disease; 5)other screening for suspected conditions (not mental disorders orinfectious disease); 6) edema; 7) abdominal pain, unspecified site; 8)other upper respiratory disease; 9) unspecified symptom associated withfemale genital organs; and 10) chronic vascular insufficiency of theintestine. The one or more programs determined that the most predictiveprocedures include: 1) office or other outpatient visit for theevaluation and management of an established patient; 2) otherlaboratory; 3) office or other outpatient visit for the evaluation andmanagement of an established patient; 4) laboratory: chemistry andhematology; 5) other therapeutic procedures; 6) pathology; 7) otherdiagnostic radiology and related techniques; 8) microscopic examination(bacterial smear, culture, toxicology); 9) office or other outpatientvisit for the evaluation and management of an established patient; and10) nonoperative urinary system measurements. The one or more programsdetermined that the most predictive therapies include: 1) androgens andcombinations; 2) blood derivatives; 3) unspecified agents; 4)sympathomimetic agents; 5) adrenals and combinations; 6)analgesics/antipyretics; opiate agonists; 7) antibiotics: penicillins;8) antibiotics: erythromycin and macrolide; and 9)analgesics/antipyretics; nonsteroidal anti-inflammatory drugs. The oneor more programs determined that the most predictive providersinclude: 1) outpatient hospital; 2) office; 3) independent laboratory;4) emergency department (hospital); 5) inpatient hospital; 6)independent clinic; 7) patient home; 8) outpatient (not elsewhereclassified); 9) ambulatory surgical center; and 10) ambulance (land).

As will be described in more detail below, and as illustrated utilizingFIGS. 1-3, in embodiments of the present invention, one or more programsobtain (exclusively) machine-readable electronic medical records ofindividuals who were previously medically diagnosed with a disease, suchas HAE. The one or more programs analyze (mine) the data utilizing bothfrequency ranking and by identifying mutual information. Thus, theprogram code in some embodiments of the present invention employs ananalysis that utilizes two data-ranking methods: a frequency method anda mutual information method. The program code utilizes the mutualinformation measure to quantify the statistical relevance of everyfeature in the electronic data set(s) of medical records to a future HAEdiagnosis. The program code computes the relative frequency of pertinentevents to rank the differentiating features based on the mutualinformation measure. Based on frequency ranking and mutual information,the one or more programs identify distinguishing features in categoriesthat include diagnoses, procedures, drugs, providers, and locations.Based on identifying the distinguishing features, the one or moreprograms generate predictors (e.g., an adaptive data model), that theone or more programs can apply to data sets where it is unknown whetherthe individuals represented have HAE, and based on applying the model,the one or more programs can identify probabilities of HAE being presentamong the individuals represented.

Returning to FIG. 1, FIG. 1 is an example of a workflow 100 of anembodiment of the present invention which includes, as described above,data integration, pattern extraction, and population separation. FIG. 2provides an overview 200 of portions of FIG. 1, as the aspects of dataintegration, pattern extraction, and population separation are alsoillustrated in FIG. 2.

As seen in FIG. 2, data integration 210 includes patient definition,where one or more programs generating a patient definition by analyzingelectronic records that include, but are not limited to, clinical andnatural history data, expert input, and drug and diagnosis codes, overtime, and across multiple de-identified data sets. The one or moreprograms in embodiments of the present invention perform patternextraction 220, which the one or more programs extract features andcreate a disease (or event) model creation refining the patient profileand applying machine learning and information theoretic techniques. Inpopulation separation 230, the one or more programs make a prediction.Based on the one or more programs completing the development of diseasemodels, the one or more programs applies the developed models to theremaining population, which enables the one or more programs to identifyundiagnosed patients, in addition to diagnosed by untreated patients

Returning to FIG. 1, in some embodiments of the present invention, theprogram code defines filter parameters for a given event (110). Thefilter parameters include data points where patterns could be relevantto the event. For example, if the event is the diagnosis of a givendisease, filter parameters may include one or more of disease/diagnosticcodes for various comorbid conditions, prescription drugs, inpatientand/or outpatient procedures to diagnose and/or treat symptoms of thedisease, visits to specialists, etc. In an embodiment of the presentinvention, the disease/diagnostic codes may comprise diagnostic codes,such as International Statistical Classification of Diseases and RelatedHealth Problems codes, referred to as ICD-9 codes and the newer ICD-10codes. In embodiments of the present invention, in order to define apatient with HAE, the one or more programs identified a group ofpatients in a database (e.g., a medical claims database) who definitelyhad HAE. As aforementioned, the one or more programs may identify theseindividuals (who are then utilized to create the patient definition)utilizing diagnosis codes from International Classification of Diseases,Ninth Revision, Clinical Modification (ICD-9-CM). However, in somecases, these codes alone may not be fully reliable for use by the one ormore programs because a code may be used for billing purposes withoutofficial diagnosis. Also, old codes may be used even after new, morespecific codes become available. Also, an ICD-9-CM code sometimesrepresents a group of diseases. Finally, data entry errors can occurwhen entering data that one or more programs utilize to create andupdate the contents of database. In the case of HAE, the one or moreprograms, in addition to the codes, identified the patients whodefinitely had the disease by obtaining data (see, e.g., FIG. 9, 910,expert input) indicating that patients prescribed 1 of the 4HAE-specific drugs available in the United States are patients with HAE.These 4 drugs are Cinryze (C1 esterase inhibitor [human]; Shire),Firazyr (icatibant; Shire), Berinert (C1 esterase inhibitor [human]; CSLBehring), and Kalbitor (ecallantide; Shire). Thus, in the example ofbuilding a model to identify HAE, the one or more programs identifiedpatients identified in the database as being prescribed 1 or more ofthese 4 drugs to form the population of index HAE patients. In oneexample, the one or more programs identified patients with HAE bysearching a medical claims database with the records of over 180 millionindividuals, ranging in dates from 2006-2014, and identified patientswith HAE based on locating all patients prescribed two C1 inhibitors[human] (Cinryze, Berinert), incatibant (Firazyr), and ecallantide(Kalbitor). The identification located 1002 index patients with HAE.

Based on the filter parameters, the program code parses a data set inwhich the event is present in each record and identifies patterns(comprised of features) across records that relate to these parameters(120). For a HAE, the program code may identify mutual information ofall categories of potentially relevant features such as, for example,for comorbid diagnoses, prescription drugs, provider visits, treatmentlocations, and/or medical procedures. As discussed above, in someembodiments of the present invention, the one or more programsidentified mutual information related to diagnosis, procedural,therapeutic, and healthcare provider characteristics, which areenumerated above.

In an embodiment of the present invention, the data set analyzed by theprogram code comprises medical information (e.g., records) related to apopulation of individuals with a given disease. For example, the dataset may include, coupled with the timing for each feature, diagnosticcodes, D_(x)(t), (e.g., ICD-9 codes, ICD-10 codes), procedures (e.g.,Proc(t)), drug treatments, including prescriptions (e.g., Drug(t)),provider visits (Provider(t), and/or the location(s) of each individualrepresented in the data set (e.g., Location(t)). Locations may include,but are not limited to, locations of providers who interacted with apatient, a ZIP code related to a practice and/or a patient, ametropolitan area identifier, etc. The constant in the data set is thatit is a known that each individual represented by the data has aspecific medical condition, including a particular disease. Theindividual factors or features in the data set can also be referred tocollectively as codes.

One or more programs in an embodiment of a present invention mayinitially identify a population with HAE by electronically isolating agroup of records that include individuals definitively diagnosed withthe HAE, by utilizing one or more of an ICD-9 code and/or a ICD-10 codespecific to HAE, from all patients in the national dataset that includesthe electronic medical records of over 180 million patients. In order tofurther isolate a data set for use in predictive feature analyses (e.g.,population separation, FIG. 2, 230), the one or more programs filteredthis initial data (110) by identifying, from these electronic records,records that represented individual across all the states in the UnitedStates with a minimum of one year of adjudicated claims history prior tothe implementation of the diagnosis code for the particular disease inthe records.

Referring to FIG. 1 and the example of identifying a pattern for HAE ora given disease, including an orphan disease or other rare disease, inorder to identify patterns (e.g., FIG. 1, 120), in an embodiment of thepresent invention, program code identifies a patient temporal signal,i.e., the codes and the combination of codes that separate individualswith a given condition, for example, from a general population. In anembodiment of the present invention, the program code utilizes featureselection techniques to identify the mutual information in the data setthat can be utilized to characterize the given condition. The programcode may utilize this mutual information as an inclusion/exclusionindex. For example the codes selected through mutual information providethe inclusion criteria for patients to be selected by one or moreprograms and conversely, those patients who do not possess any of thecodes within this set, are excluded by the one or more programs. Thegoal of feature selection is to define the smallest subset of featuresthat collectively contain most of the mutually shared information andthus most clearly define the characteristics of a patient with a givendisease. The one or more programs determined the relative frequency ofpertinent events to rank the differentiate features based on the mutualinformation measure. To build a model for identifying potentialindividuals to be tested for HAE, the one or more programs in someembodiments of the present invention utilized insurance claims datacomposed of de-identified diagnosis-related details and paymentinformation. A national claims database utilized to build the model andlater to score patients aggregated data for more than 176 million USpatients from 2006 to 2014. Claims datasets enable for in-depthassessment of health and quality outcomes when analyzed with toolscapable of handling datasets of this size, such as aspects ofembodiments of the present invention.

By determining mutual information, the program code in embodiments ofthe present invention uncovers consistent data over voluminous recordsthat would be impossible outside of the specialized processing, which isdiscussed herein. In embodiments of the present invention, the programcode applies frequency ranking and mutual information procedures toidentify the distinguishing features that include diagnoses, procedures,drugs, providers, and locations, which the program code later uses todetermine predictors of the HAE. The program code may also take intoaccount feature continuity when determining predictors, as differentpatterns may emerge within the data at different times. For example, fora given disease, the program code may determine that the occurrence ofcertain patient features increase over time (e.g., in a 5-year cohort),while certain disorders (e.g., nervous system disorders and otherconnective tissue disease) increase disproportionately as patientsapproach diagnosis (by a medical professional), and that other medicalconditions (e.g., unspecified diseases of the spinal cord and primarylateral sclerosis) change relatively little over time. In the case ofHAE, the one or more programs determined diagnostic, procedural,therapeutic, and healthcare provider characteristics most predictive ofHAE.

Using the described analytic methods, the program code identifiesfeatures in the claim histories of individuals who were medicallydiagnosed with HAE, that differentiate these individuals from thegeneral population, before they received the disease diagnosis. Forexample, the program code determines a group of features or a patternthat is common to these individuals at a time when not enoughinformation was available to the medical professional treating theindividuals to make the eventual diagnoses. The program code maydetermine, for a given disease, that medically significant predictorsseen in patients who were eventually diagnosed with the disease include,but are not limited to, nervous system disorders, hereditary anddegenerative nervous system conditions, connective tissue disease, skindisorders, lower respiratory disease, gastrointestinal disorders,neurologist visits, orthopedic surgeon visits, gastroenterologistvisits, non-traumatic joint disorders, otolaryngologist visits, and theuse of certain medications, prior to diagnosis. As is discussed herein,upon identifying the differentiated features, the program code analyzescombinatorial features that differentiate undiagnosed patients from thegeneral population to further characterize early predictors of thedisease, and optimize the algorithm differentiating patients with thedisease, prior to diagnosis. For HAE, the program code determined thatthe most predictive diagnoses, in weighted order, include: 1) allergicreactions; 2) swelling, mass, or lump in head and neck; 3) routinegeneral medical examination at a healthcare facility; 4) immunizationsand screening for infectious disease; 5) other screening for suspectedconditions (not mental disorders or infectious disease); 6) edema; 7)abdominal pain, unspecified site; 8) other upper respiratory disease; 9)unspecified symptom associated with female genital organs; and 10)chronic vascular insufficiency of the intestine. The one or moreprograms determined that the most predictive procedures include: 1)office or other outpatient visit for the evaluation and management of anestablished patient; 2) other laboratory; 3) office or other outpatientvisit for the evaluation and management of an established patient; 4)laboratory: chemistry and hematology; 5) other therapeutic procedures;6) pathology; 7) other diagnostic radiology and related techniques; 8)microscopic examination (bacterial smear, culture, toxicology); 9)office or other outpatient visit for the evaluation and management of anestablished patient; and 10) nonoperative urinary system measurements.The one or more programs determined that the most predictive therapiesinclude: 1) androgens and combinations; 2) blood derivatives; 3)unspecified agents; 4) sympathomimetic agents; 5) adrenals andcombinations; 6) analgesics/antipyretics; opiate agonists; 7)antibiotics: penicillins; 8) antibiotics: erythromycin and macrolide;and 9) analgesics/antipyretics; nonsteroidal anti-inflammatory drugs.The one or more programs determined that the most predictive providersinclude: 1) outpatient hospital; 2) office; 3) independent laboratory;4) emergency department (hospital); 5) inpatient hospital; 6)independent clinic; 7) patient home; 8) outpatient (not elsewhereclassified); 9) ambulatory surgical center; and 10) ambulance (land).

Returning to the analysis to generate the predictive model, inembodiments of the present invention, as discussed above, for eachcategory represented in the data set, the program code analyzes items inthose categories over time and notes the absence or presence of eachitem that appears in the data set for each category. Returning to thedisease example, in an embodiment of the present invention, the programcode separately analyses codes in each of the following categories:D_(x)(t), Proc(t), Drug(t), Provider(t), Location(t)). The one or moreprograms considers features including diagnosis codes, procedure codes,medications, standard provider types, and/or standard care facilitytypes.

Table 1 below illustrates an analysis of the program code of thepresence and absence of certain items in a given category utilizing theorphan disease identification example. In Table 1, the variables 1 and 0serve as binary variables and the heading are categorical variable whichtogether represent whether the given item (category) is absent orpresent at a given time. In the example of Table 1, the diagnosis codesassigned to individuals by medical professionals, in the data set, overtime, are analyzed by the program code. In an embodiment of the presentinvention, the program code repeats this analysis for procedures, drugs,and the locations of the individuals represented in the records in thedata set. As is understood by one of skill in the art, program codeperforming the analysis can identify nuances in the vast data set withina workable timeframe (e.g., during the visit of an individual to ahealth care provider) based on the utilization of the processing powerof the computer system upon which aspects of the present invention areimplemented. FIGS. 4-7, which will be discussed herein, includecomputing configurations that are customized to handle the processingdemands that the analysis performed by the program code utilizes

TABLE 1 Pat(N) t₁ t₂ t₃ . . . t_(n) D_(x)1 1 0 1 1 D_(x)2 0 1 0 0 . . .D_(x)n 1 1 1 1

Referring back to FIG. 1, once the program code has identified patterns,in an embodiment of the present invention, the program code may weighthe features comprising the patterns in order of significance and removedata that do not include top features (130). Embodiments of the presentinvention employ more than one method of weighing and selectingsignificant features. As discussed in the HAE example, the program codemay rank the features based on the raw mutual information values.However, in some embodiments of the present invention, the program codemay view the output of a classifier, e.g., SVM or random forest thatwill provide a numerical measure of the feature importance that can thenbe ranked. In an embodiment of the present invention, the program codemay weigh a feature with more mutual information across records as moresignificant. Thus, the program code selects top features (i.e., featureswith largest values of mutual information, down to the level ofsignificance) from each of the categories and orders them in descendingorder (according to the values of mutual information). By removing datathat does not include top features, the program code focuses theanalysis and increases the efficiency in later identifications. Theuniverse of data related to, for example, individuals suffering from anorphan disease, may be extremely vast, and by weighing features of thedata, the program code is able to consolidate the data set into a moremanageable amount for processing. In an embodiment of the presentinvention, the program code determines the frequency of a code andrepresents this frequency with a number between 0 and 1. The programcode utilizes these frequency codes to perform binning based on howoften each item occurs within the data set.

For ease of understanding, Table 1 displays binary values (1 and 0),however, a data set that is analyzed may include more than one event ina specific time slot, thus, a binary representation, such as Table 1 isnot fully representative of this aspect of an embodiment of the presentinvention and is offered merely for ease of understanding. In fact, fora specific condition or disease, the table would not be binary, butwould contain numerical values as the numerical values would representfrequency of a code appearing in a patients' health journey. In anembodiment of the present invention, the values in a matrix canrepresent the presence or absence of a code in a patient's history (asseen in Table 1), but can also represent the frequency with which thecode occurs in that time slot. For example, if each column represents amonth, then the numerical value can represent (1) the absence orpresence of a code, (2) the number of times that code appears in thattime slot, (3) the average frequency with which that code appears inthat time slot, and (4) any function that can be applied to the value torepresent events in that time slot.

Aspects of embodiments of the present invention utilized to generatemutual information are the same regardless of the condition for whichthe program code is constructing this information. Thus, embodiments ofthe present invention are portable over an unlimited number of data setsand can be utilized to identify an unlimited number of events orconditions. As described above, the program code indexes tables in orderto derive tables for use in the analysis and, as explained in FIGS. 4-7,the computing is distributed based on the processing demands of theprocesses performed by the program code to generate the mutualinformation. In embodiments of the present invention, the program codecomputes mutual information for each feature as an independent process.The program code computes mutual information a specific feature and anoutput class variable. Computing the mutual information of two featuresin separate processes will not affect the result of either computedmutual information result.

Returning to FIG. 1, in an embodiment of the present invention, theprogram code may pre-process remaining data (140). For example, in anembodiment of the present invention, the program code may use a binningprocedure using the average value of the corresponding feature asthreshold, for example, values above the threshold are coded as 1, andvalues below it as 0.

In an embodiment of the present invention, after pre-processing theremaining data, in embodiments where this part of the process isincluded, the program code utilizes the pre-processed data or accessavailable data sets to build a training set by using statisticalsampling (150). The training set includes data representing the eventand data that represent an absence of the event. In some embodiments ofthe present invention, the training set comprises electronic recordsthat are only readable by a computing resource.

The program code formulates the training set by proportionally selectingrepresentative electronic records from the target and controlpopulations: the target population is the population with the condition(e.g., event, disease) and the control population is the population isthe negative case (to distinguish from the target). Thus, in the examplewhere an event is a disease, the training set includes disease entriesand healthy entries. Departing from the specific disease example, in anembodiment of the present invention, the program code utilizes a testset of training data to train the machine learning algorithm. Thetraining set is selected to include both records with the occurrence orcondition the algorithm was generated to identify, and records absentthis occurrence or condition. The program code tests/trains theindividual features that comprise the mutual information (and/or othertechnologies discussed herein) selected to identify a given condition,and utilizing voting and ensemble learning, trains the algorithm.

In an embodiment of the present invention, the program code may utilizethe training set with the significant patterns identified in theanalysis to construct and tune a machine learning algorithm, such thatthe algorithm can distinguish data comprising the event from data thatdoes not comprise the event (160). The machine learning algorithm may bea linear SVM classification algorithm, which can be utilized with one ormore of an RF grouping algorithm and/or a log regression. If the eventis a disease, including an orphan disease, the program code may trainthe machine learning algorithm to separate database entries representingindividuals with a disease from entries representing healthy individualsand/or individuals without this particular disease. The program code mayutilize the machine learning algorithm, may assign probabilities tovarious records in the data set during training runs and the programcode, may continue training the algorithm until the probabilitiesaccurately reflect the presence and/or absence of a condition in therecords within a pre-defined accuracy threshold. With HAE, the programcode utilizes a support vector machine (SVM) classifier. The programcode made a selection based on a comparative assessment of variousclassifiers. When building a model for HAE, in some embodiments of thepresent invention, the program code utilizes Random Forest to generatepredictors.

In some embodiments of the present invention, using the disease example,the training set represents a patient population that had the disease.This defined patient population may consist of a constellation of codes,(diagnosis, procedures, drugs, etc.). The machine learning algorithm,which is discussed herein, learns from this defined patient population.In essence, the machine learning algorithm uses a surrogate patientpopulation to find the undiagnosed patients. Stated in another way, thesurrogate patient population consists of the patients known to have thedisease, and the machine learning algorithms encode their pre-diagnosischaracteristics to find similar patients and process the retrospectivepatient journey to predict the prospective patient journey. In thepatient definition process (see, e.g., FIG. 2, 220) the program codeidentifies cohort of patients that the machine learning algorithm willlearn from; this patient cohort will serve as the training set. Inembodiments of the present invention, the internal algorithms applied bythe program code include, but are not limited to: 1) mutual informationto inform or refine the patient definition; and/or 2) various dataminingtechniques, including but not limited to, histograms to captureprocedures, drugs, diagnosis codes, specialty types, geographiclocation, patient demographics (age, gender), and co-morbidities.

As aforementioned, in an embodiment of the present invention, theprogram code constructs the machine learning algorithm, which can beunderstood as a classifier, as it classifies records (which mayrepresent individuals) into a group with a given condition and a groupwithout the given condition. In an embodiment of the present invention,the program code utilizes the frequency of occurrences of features inthe mutual information to identify and filter out false positives. Theprogram code utilizes the classifier to create a boundary betweenindividuals with a condition and the general population to lowermulti-dimensional planes, given multiple dimensions, including, forexample, fifty (50) to one hundred (100) dimensions. When embodiments ofthe present invention are employed to build a model to predict some HAE,the one or more program employ an ensemble of classifiers developedemploying machine learning techniques to optimize the selection andranking of HAE diagnosis predictors (see, e.g., FIG. 2, 230).

As part of constructing a classifier (machine learning algorithm), theprogram code may test the classifier to tune its accuracy. In anembodiment of the present invention, the program code feeds thepreviously identified feature set into a classifier and utilizes theclassifier to classify records of individuals based on the presence orabsence of a given condition, which is known before the tuning. Asaforementioned, the presence or absence of the condition is not notedexplicitly in the records of the data set. When classifying anindividual with a given condition utilizing the classifier, the programcode may indicate a probability of a given condition with a rating on ascale, for example, between 0 and 1, where 1 would indicate a definitivepresence. The classifier may also exclude certain individuals, based onthe medical data of the individual, from the condition.

In an embodiment of the present invention, the program code constructsmore than one machine learning algorithm, each with different parametersfor classification, based on different analysis of the mutualinformation, and generates an ultimate machine learning algorithm basedon an aggregation of these classifiers.

In an embodiment of the present invention, to decrease the instances offalse positive results, in an embodiment of the present invention, whenthe algorithm is an SVM algorithm, the program code collects falsepositive results and sorts them according to their SVM score in order toidentify false positives. In an embodiment of the present invention, toincrease the comprehensibility and usability of the result, the programcode post-processes records identified as including the event accordingto pre-defined logical filters. These pre-defined filters may beclinically derived (e.g., only males have this disease). In the diseaseexample, the result of applying the classification algorithm is a sortedlist of individuals suspected of having the disease.

Departing from the specific disease example and returning to FIG. 1,based on training the machine learning algorithm, the program codeapplies the constructed classification algorithm to the available datato identify records, including the event, and produces a list ofoccurrences (170). In some embodiments of the present invention, theconstructed classification algorithm is a database object that is storedin a memory resource that is communicatively coupled to the processingresource executing the program code. In some embodiments of the presentinvention, the list produced is a machine-readable data set that issaved by the program code in stored in a memory resource that iscommunicatively coupled to the processing resource, including but notlimited to, a relational database. As discussed earlier, this process isillustrated in FIG. 2.

FIG. 3 is a workflow 300 of certain aspects of an embodiment of thepresent invention. In order to offer a comprehensive example of theoperation of an embodiment of the present invention, FIG. 3 uses diseaseidentification in population data as an example of the invention'scapability in identifying events across one or more data set. Aspects ofthis workflow 300 are relevant to the specific HAE model disclosedherein. FIG. 3 also demonstrates how the machine learning utilized inthe present invention is a continuous process and an evolving process.The training of an algorithm, including but not limited to, an SVMalgorithm and/or a random forest algorithm, can be an ongoing anditerative process. For example, the algorithm may include a machinelearning algorithm that is continuously trained by the program code asvalidated samples and their extracted patterns are applied to thetraining algorithms.

Referring to FIG. 3, the program code receives data related to a patientpopulation diagnosed with a given disease (310). This data is providedin the form of machine-readable electronic medical records. Thus, theprogram code obtains the data. From the data, the program code isolatesdata defining a general control population (320). In an embodiment ofthe present invention, the control population serves as a negativeexample to the learning algorithm. In addition, the control populationcan incorporate clinically derived comorbidities to distinguish furtherthe population with the disease from the population without the disease.The program code identifies mutual information across the records of thepatients in the general control population (330). The program codeselects features common to the records and weighs the features inaccordance with commonality (340). The program code selects features ofa pre-defined weight and utilizes those features to generate a machinelearning algorithm (350). In an embodiment of the present invention, theprogram code selects features that meet a certain pre-defined thresholdbased upon the prevalence of the feature in the initial data set. In anembodiment of the present invention, the model defines a group offeatures for an individual with the disease.

The program code employs the machine learning algorithm to generateadditional predictions as to features that may be common among thepreviously diagnosed population (360). Returning to the example of HAE,the one or more programs in embodiments of the present invention mayderive predictors (e.g., diagnosis predictors, see FIG. 2, 230) bydifferentiating features selected by mutual information andranking/weighing the features utilizing relative frequency. In someembodiments of the present invention, the one or more programs maygenerate additional predictions by utilizing data in particular timeperiods. In building predictors for some diseases, including HAE, theone or more programs in an embodiment of the present invention generatepredictors utilizing various time brackets, based on the one or moreprograms determining that the predictors of a given disease within adata set change over time, with the progression of the disease.

As will be understood by one of skill in the art, patterns orcommonalities in the data among various individuals with a givencondition may not be readily apparent when the program code scans thedata. For this reason, the machine learning algorithm assists theprogram code in predicting what some commonalities may be, based onalready-identified commonalities. The program code can then test whetherthese predictions represent actual patterns. When a prediction issufficiently prevalent, the program code updates the pattern andtherefore, the machine learning algorithm, to include this quality.

The identification of features, generation of a model, and generation ofprediction for additional features, is an iterative process that tunesthe machine learning algorithm that the program code ultimately utilizesto identify undiagnosed patients in an expanded data set. Additionally,the program code can utilize features derived from one data set in ananalysis of another data set. Thus, based on the predictions, theprogram code selects features common to the records and weighs thefeatures in accordance with commonality (340). The program code selectsfeatures of a pre-defined weight and utilizes those features to updatethe model (350). Thus, the machine learning aspect of an embodiment ofthe present invention is iterative.

As demonstrated in FIG. 3, not only does the program code train amachine learning algorithm based on weighted mutual informationinitially identified by the program code upon obtaining and/or receivingthe data, the algorithm also generates predictions for data that mayexist in the data set that was not initially identified, enabling theprogram code to further analyze the data based in these predictions,validate or invalidate the predictions, and based on this result,further train the algorithm to improve its ability to identify, forexample, undiagnosed patients with a given disease.

Returning to FIG. 3, the program code applies the machine learningalgorithm to identify undiagnosed individuals with a disease in a largerpopulation (360).

In an embodiment of the present invention, the program code can alignthe determination of a diagnosis for a given individual with the timingof the diagnosis as related to items in the mutual information thatmatch up with the data related to the individual.

An important challenge of identifying an isolated event in a data setutilizing a machine learning algorithm that can utilize unlimitedparameters of varying complexity is that the computation can beextremely inefficient, as the algorithms scale non-linearly. Thus, whenthe program code trains and applies the machine learning algorithm toidentify undiagnosed individuals with a disease in a larger population(360), in embodiments of the present invention, the queries utilized inthe training and application of the algorithm are distributed toincrease the efficiency of the process. Specifically, in an aspect ofcertain embodiments of the present invention, the program code receivesqueries throughout the process of identifying the events in the data setand evaluates the complexity of the queries before assigning a computerresource to answer the query. For example, in an embodiment of thepresent invention, the program code decides where to route a query basedon the complexity of the anticipated answer to the query. In thismanner, the program code sends a straightforward database query that canbe answered with a single value pulled from a data set in response to aresource configured to respond efficiently to this type of query.Meanwhile, queries that require more complex responses, such as queriesincluded in the execution of the machine learning algorithm, may bedistributed over a group of resources to maximize efficiency, withoutcompromising functionality.

In an embodiment of the present invention, the program code builds andimproves the model through machine learning at a granular level. Themodel building code architecture is integrated in the sense that theonly input needed is a list of patient IDs (de-identified patient IDnumbers), and a list of features to include in the model. The modelbuilder sets up the testing and training sets, extracts the appropriateretrospective patient histories from the database and builds a suite ofmodels, optimizes them, ensembles them and then generates a report ontheir performance.

In an embodiment of the present invention, a database comprises a set oftables that are derived from the raw data obtained from the claims datavendor. This new data architecture combines the relevant data elementsfrom all the “raw” tables and produces tables that contain only thepertinent information used for the machine learning models. The tablesare indexed (internal database optimization) so that queries executefaster. In embodiments of the present invention, the program codederives a set of population tables from the raw tables, extracting dataelements pertinent and representative of each patient's health journey.The extracted data includes, for each record, the diagnosis code, thedate, the patient id number, the drug code, the procedure code, and allmatched to the date on the claim. In embodiments of the presentinvention, separate tables exist for the diagnosis code, drugs code,procedure code, and the specialty type.

FIG. 4 depicts a technical architecture that may be utilized by anembodiment of the present invention. In an embodiment of the presentinvention, a user utilizes a workstation 310 to connect to a distributedcomputing environment 320 over a network connection. The networkutilized can be wired, wireless or hybrid and may be public or private,depending upon the data security employed in the delivery of the data.The network may include the Internet. The distributed computingenvironment is layered in order to service efficiently the queries andmachine learning of the method. Layers includes a visualization layer330 responsible for delivery of comprehensive results, an analysis layer340 responsible for processing and responding to queries that requirestraightforward data access answers, a data language layer 350 toextract, transform, load, generate derived tables to increaseefficiency, extract and prepare data for machine learning algorithms,and/or apply information theoretic techniques to extract all features,and a distributed computing layer 360 responsible for allocatingresources for processing various threads utilized in embodiments of thepresent invention. The program code in the distributed computing layer360 manages at least one server 370 (the cluster of five servers in FIG.4 is merely one example used to illustrate and is not limiting). Thedistributed computing layer 360 receives each query and/or instructionand the program code in the distributed computing layer decides, basedon the type of response the query requests or the complexity of theinstruction, whether to distribute the query or instruction to aresource in of the managed resources 370 and to which resource thequery/instruction should be distributed.

FIG. 5 depicts another architecture that can be utilized by embodimentsof the present invention. In this technical environment, rather than adata languages layer, a combined data/distribution management layer 460layer manages distribution to the managed resources 470, as well as toat least one dedicated processing resource 480, which handles themachine learning. This dedicated processing resource 480 can handlemultiple threads simultaneously. At the data/distribution managementlayer, the program code receives a query and based on the type ofresponse the query is requesting, the program code decides whether todistribute the query to the managed resources 470 or to answer the querywith the resource in the data/distribution management layer 460. Inembodiments of the present invention, general database queries arehandled by resources at the data/distribution management layer 460without further distribution. In addition, the distributingfunctionality, program code executing on resources in thedata/distribution management layer 460 also interact with the dedicatedprocessing resource to select the parameters utilized in the machinelearning.

FIG. 6 is one example of a computing environment utilized by someembodiments of the present invention that includes elements of a cloud590. In this example, the program code utilizes the resource of thecloud 590 to pre-populate data at rest so that the data utilized by theprogram code in the present invention both to train the machine learningalgorithm and ultimately to identify records with a given event (e.g.,disease) is unlimited. Aspects of certain embodiments of the presentinvention can be deployed as SaaS utilizing this cloud 590 environment.

FIG. 7 is another example of a technical environment that can be aportion of an embodiment of the present invention. In this example, aswith FIG. 6, the present invention that includes elements of a cloud590. In this example, as with FIG. 6, the program code utilizes theresource of the cloud 590 to pre-populate data at rest so that the datautilized by the program code in the present invention both to train themachine learning algorithm and ultimately to identify records with agiven event (e.g., disease) is unlimited. Aspects of certain embodimentsof the present invention can be deployed as SaaS utilizing this cloud590 environment. Utilizing the technical architecture of this figure,program code will execute: (1) on the 5 machine network, and/or (2) onAWS cloud computing infrastructure.

FIG. 8 is a general workflow 800 that illustrates aspects of variousaspects of some embodiments of the present invention. This workflow 800provides a general guide to certain features of embodiments of thepresent invention. Each aspect of this workflow 800 is performed byprogram code executed by at least one processing circuit. As illustratedin FIG. 8, the program code performs patient definition 810, featureextraction 820, feature selection 830, machine learning based classifierdevelopment 840, and prediction of the remaining patients in thedatabase 850.

The application of certain aspects of embodiments of the presentinvention to the identification of diseases can be understood in thecontext of the example that follows. Below, for HAE, data related to thedemographics of a patient population diagnosed with HAE was obtained byone or more programs from a database of de-identified patient claimsdata acquired from an insurance claims database. For example, a databaseutilized in an embodiment of the present invention may comprise datacovering eight years. An embodiment of the present invention wasutilized to discover patients within this database who had not yet beendiagnosed with HAE. The description is genericized in order toillustrate the functionality.

Stage 1: Patient Definition (e.g., FIG. 2, 210; FIG. 8. 810)

In order to identify individuals with HAE in the database to utilize inorder to ultimately identify other individuals, the one or more programsdefine a HAE patient by utilizing information in the records related toICD-9 and certain HAE-specific drugs, here referred to as Drug 1, Drug2, and Drug 3. This set of patients is referred to as the “goldstandard” HAE group. For example, the patient definition used for HAEmay consist of the ICD-9 and ICD-10 diagnosis codes along with therelevant drugs. The program code may apply a set of definitions, whichmay include or exclude drugs. In some embodiments of the presentinvention, the definition applied by the one or more programs may alsoinclude or exclude related conditions, along with a specificrepeatability that the one or more programs identify by observing thecodes.

Stage 2: Model Creation (e.g., FIG. 2, 220; FIG. 8. 820-840)

In order to identify which features or combination of features are moststatistically relevant for differentiating HAE from non-HAE patients, aninformation-theoretical concept of mutual information was utilized todetermine the differentiating features. As discussed earlier, mutualinformation is a measure of how much information about one set of datacan be determined from another set of data. Features or theircombinations with higher mutual information values are likely to be moreinformative for discriminating HAE from non-HAE patients.

After the program code determines the mutual information of individualfeatures or their combinations, the program code begins featureselection. The goal of feature selection is to define the smallestsubset of features that collectively contain most of the mutually sharedinformation and thus most clearly define the characteristics of the HAEpatient. As discussed above, machine learning algorithms drive theanalysis of feature selection that created a model of HAE. Thus, theprogram code generates a model consisting of the fewest possible andsimultaneously most differentiating characteristics of the HAE patients,resulting in an enhanced patient definition.

Stage 3: Prediction (e.g., FIG. 2, 230; FIG. 8. 850)

Once the program code determines a model of the characteristics of theHAE patient from the gold standard HAE patients, the program code scoresthe remaining population of patients in the data set by the model tofind undiagnosed patients. In order to score patients, the program codecomputes the features for every patient in the data set not in the setof gold HAE patients. Each patient's features (or characteristics) wereinput by the program code to the HAE computer model and the program codeproduced a numerical score. This numerical score is the likelihood thatthe patient is an undiagnosed HAE patient. The numerical score can beused to rank patients from those who are most likely to be undiagnosedwith HAE to those that are least likely to have HAE. As discussed above,embodiments of the present invention are designed to handle an unlimitedamount of data, thus, in building and applying models and later, makingpredictions based on the model, the program code has generated scoresfor over 180 million patients without temporal delays. The prioritizedlist may be used to allocate resources to address the needs of thehighest likely patients.

In an embodiment of the present invention, once the one or more programsgenerated a model based on determining the characteristics of thepatient with HAE from the index patients with HAE, the one or moreprograms scored the remaining population of patients in the data set,utilizing the model, to find undiagnosed patients. For, the one or moreprograms determine features that did not appear in the set of indexpatients with HAE. The one or more programs obtain each patient'sfeatures and input these features into the HAE model. The result of theone or more programs applying the model to the features is a numericalscore that represents the likelihood that the patient had undiagnosedHAE. In an embodiment of the present invention, the one or more programsrank the identified patients, based upon the assigned scores, from mostlikely to least likely to have the condition.

In an embodiment of the present invention, the training set is processeddynamically and informs and tunes the model and the data of unknownpatients is continually utilized to tune the model. For example, duringthe building phase of the model, the output of the model with a trainingset input, is compared to a known label (patient with disease or not)(supervised learning). The error is used to modify the internalparameters of the model. This process continues until the error isminimized. However, once the model is built, it is then used to scorethe patients. For each patient (e.g., of the at least 180 million), thefeatures are computed and fed through the model. The output of the modelindicates whether the patient is a likely undiagnosed disease patient ornot. (The output is binary.)

Stage 4: Validating HAE Patients

There are at least two approaches considered to validate that thepredicted undiagnosed HAE patients actually have the condition invarious embodiments of the present invention. The first approach is toperform a field validation, where the appropriate personnel are deployedat providers to educate them on the characteristics of potential HAEpatients. The providers would then call in those patients and get themtested for HAE. This process could take several months. An alternativeapproach is to monitor the health claims of the predicted patients overtime. As the healthcare claims data is updated (monthly), the programcode flags new HAE patients with a definitive diagnosis indication. Inthis manner the number of predicted undiagnosed patients that arevalidated to have the disease can be determined without engaging thesales force or medical science liaisons. In addition how far ahead intime the prediction was made before the true diagnosis can bedetermined.

In some embodiments of the present invention, included in the electronicrecords is provider information associated with each patientrepresented, as well as the patient's claims. Thus, if the one or moreprograms scores a patient as having a likelihood of a disease within acertain threshold, the one or more programs may electronically notifythe provider of this result.

The information identified by the program code and incorporated in themodel may include age, gender, diagnosis codes, procedures,prescriptions, provider types, and facility types. As discussed above,program code in an embodiment of the present invention may store theresultant model in a database and continually update/tune the model asthe repeated application provides more intelligence.

FIG. 9 illustrates various aspects of some embodiments of the presentinvention. In this example, embodiments of the present invention utilizeelectronic medical records (including those from a claims database) asinputs, but also utilize additional information in order to define apatient population. As illustrated in FIG. 9, one or more programs in anembodiment of the present invention analyzes clinical/natural history,expert input, and drug and diagnosis codes over time, in order todetermine an initial patient definition 910 for a given disease. Asillustrated in FIG. 9, the individuals the program code differentiatesthe individuals who fit the initial patient definition that itdetermines from a general population, all of whom are representedelectronically in at least one database. The patient definition 910 canbe understood as the statistical “signature” of the given disease. Insome embodiments of the present invention, the program code analyzesdiagnosis codes from International Classification of Diseases, NinthRevision, Clinical Modification (ICD-9-CM) to build the patientdefinition. However, in the event that these codes, alone, do notproduce a definitive definition, due to the coding code the recordsbeing unreliable (e.g., without official diagnosis; old codes may beused even after new, more specific codes become available, an ICD-9-CMcode sometimes represents a group of diseases, and/or data entry errorshave occurred), additional information may be utilized. With certaindiseases, drugs prescribed to patients before diagnosis are indicatorsof an eventual diagnosis. Additionally, certain embodiments of thepresent invention may request and receive user inputs when building thepatient definition. During the patient definition building process, theone or more programs may prompt the user, through a graphical userinterface, for additional input. For example, the one or more programsmay recognize a trend with certain drugs and may pose a question to theuser regarding how to weight this factor in building the definition.

The one or more programs generate a model 920 of the disease by refiningthe initial patient profile through machine learning to generate adisease model. As illustrated in FIG. 9, the individuals in a populationwho fit the enhanced disease definition in a subset of individual thatfit the initial definition, which is a subset of the total population.To identify which features or combination of features are moststatistically relevant for differentiating patients with a certaindisease from patients without this disease, in some embodiments of thepresent invention, the program code utilizes mutual information todetermine the differentiating features. As discussed above, mutualinformation is a measure of how much information about one set of datacan be determined from another set of data. The features with highermutual information values are likely to be more informative fordiscriminating patients with a given disease from those without thegiven disease. After the program code determined the mutual informationof individual features or their combinations, the program code begins toselect features to define the smallest subset of features thatcollectively contain most of the mutually shared information and thusmost clearly define the characteristics of the patient with the disease.The program code utilizes machine-learning algorithms to drive theanalysis of feature selection to create the model. Thus, the modelgenerated by the program code in an embodiment of the present inventionincludes the fewest possible and simultaneously most differentiatingcharacteristics of patients with the given disease, resulting in thepictured enhanced patient definition.

The one or more programs predict which individuals of a remainingpopulation have a relevant probability of being diagnosed with thedisease 930. The one or more programs apply disease model to theremaining population in order to identify individuals who may bediagnosed with the disease in the future, based on matching the diseasemodel to a relevant degree. As seen in FIG. 9, the undiagnosed patientsare a subset of the remaining population. As illustrated, once theprogram code generated a model of the characteristics of the patientwith a given disease from the index patients with the given disease, theprogram code utilized the model to score the remaining population ofpatients in the data set to find undiagnosed patients. For everyremaining patient in the data set, the program code computes thefeatures that did not appear in the set of index patients with thedisease. The program code inputs each patient's features in the model,which produces a numerical score. This score represents the likelihoodthat the (undiagnosed) patient has the disease. In some embodiments ofthe present invention, the program code ranks the patients from mostlikely to least likely to have the condition.

FIG. 10 depicts a distribution of potential HAE patients withinmetropolitan statistical areas as determined by certain aspects of someembodiments of the present invention. The one or more programs made thisdetermination is this example utilizing data from 2006-2014 whereN=5511. To predict (e.g., FIG. 9, 930) a model of the HAE patient'shistory and profile, the one or more programs apply the enhanced patientdefinition determined during model creation (e.g., FIG. 9, 920) to theremaining population of patients in the database (or more than onedatabase). The one or more programs set the prediction classifier set toa detection probability (e.g., probability >0.8) and apply the model tothe remaining population. Based on this application of the model, theone more programs determine that there are N (5511) potentiallyundiagnosed patients with HAE in the database. In some embodiments ofthe present invention, although the data in the database isde-identified (see, e.g., FIG. 7, 690), the patient information in thedatabase is linked to metropolitan statistical areas (MSAs), whichenables the one or more programs to deliver its results in a manner thatincludes the geographic distribution of the information. The Office ofManagement and Budget defines MSAs for use by federal statisticalagencies. The distribution of the predicted HAE patients across theUnited States, as predicted by the one or more programs in an aspect ofcertain embodiments of the present invention, is depicted in the map1000 in FIG. 10.

Some embodiments of the present invention include a computer-implementedmethod, a computer system, and a computer program product where one ormore programs in a distributed computing environment, one or moreprograms obtain one or more machine-readable data sets related to apatient population from one or more databases. The one or more programsidentify, based on an initial patient definition, a portion of data fromthe machine-readable data sets related to a patient population, whereinthe portion of the data comprises patients of the patient populationwith a medical condition. Based on a frequency of features in theportion of the data, the one or more programs identify common featuresin the portion of the data and weighting the common features based onfrequency of occurrence in the portion of the data, wherein the commonfeatures comprise mutual information. The one or more programs generateone or more patterns comprising a portion of the common features. Theone or more programs generate one or more machine learning algorithmsbased on the one or more patterns, the one or more machine learningalgorithms to identify presence or absence of the given medicalcondition in an undiagnosed patient based on absence or presence offeatures comprising the one or more patterns in data related to theundiagnosed patient. The one or more programs utilize statisticalsampling to compile a training set of data, wherein the training setcomprises data from the one or more data sets and at least oneadditional data set comprising data related to a population without themedical condition, and wherein utilizing the statistical samplingcomprises formulating and obtaining queries based on the data set andprocessing and responding to the queries, the processing comprising, foreach query. The one or more programs evaluate the query to determine oneof a high or a low level of anticipated complexity of a prospectiveresponse to the query. Based on the query being evaluated at a low levelof anticipated complexity, the one or more programs assign the query toa computing resource in the distributed computing environment, whereinthe computing resource is configured to respond to low level complexityqueries. Based on the query being evaluated at a high level ofanticipated complexity, the one or more programs distribute the queryover a group of computing resources of the distributed computingenvironment to maximize efficiency, wherein the distributing comprisesassigning each computing resource of the group of computing resources aportion of the query to execute in parallel with at least one othercomputing resource of the group of computing resources executing anotherportion of the query. The one or more programs tune the one or moremachine learning algorithms by applying the one or more machine learningalgorithms to the training set of data. The one or more programsdynamically adjust the common features comprising the one or morepatterns to improve accuracy such that the one or more machine learningalgorithms can distinguish patient data indicating the medical conditionfrom patient data that does not indicate the medical condition. The oneor more programs determine, based on applying the one or more machinelearning algorithms to data related to the undiagnosed patient, aprobability, wherein the probability is a numerical value indicating apercentage of commonality between the data related to the undiagnosedpatient and the one or more patterns.

In some embodiments of the present invention, the initial patientdefinition is selected from the group consisting of: a pre-defineddiagnosis code and a pre-defined medication.

In some embodiments of the invention, the pre-defined medication isselected from the group consisting of: Cinryze, Firazyr, Berinert, andKalbitor, and the probability indicates a probability that theundiagnosed patient has the medical condition.

In some embodiments of the invention, the one or more machine-readabledata sets comprise the data related to the undiagnosed patient.

In some embodiments of the invention, the one or more programsdetermine, based on applying the one or more machine learning algorithmsto data related to each patient not included in the portion of the data,for each patient, a respective probability, wherein the respectiveprobability is a numerical value indicating the percentage ofcommonality between the data related to the undiagnosed patient and theone or more patterns.

In some embodiments of the invention, the one or more programs rank theprobability and the respective probabilities, in order of relevance andnotify, through an electronic communication, a user of an identity ofany patient in the one or more machine-readable data sets with aprobability above a predetermined threshold. The one or more programsautomatically order, based on communicating with an order managementsystem over a network connection, a clinical test for the medicalcondition, wherein a number of tests ordered is directly proportional toa number of patients with the probability above the predeterminedthreshold

In some embodiments of the invention, the generating the one or morepatterns by the one or more programs includes: ranking, by the one ormore processors, the common features based on the weighting; andretaining, by the one or more processors, the portion of the commonfeatures wherein the portion comprises common features of a pre-definedweight, wherein the portion comprises the one or more patterns.

In some embodiments of the invention, the mutual information comprisesfeatures from a plurality of feature categories and wherein each patternof the one or more patterns comprising a portion of the common featurescomprises features in one feature category of the plurality of featurecategories.

In some embodiments of the invention, the medical condition isHereditary Angioedema, and wherein the one feature category is selectedfrom the group consisting of: diagnosis codes, procedures, therapies,providers, and locations.

In some embodiments of the invention, the feature category is diagnosiscodes and a feature is selected from the group consisting of: anallergic reaction, swelling, mass, or lump in head and neck, routinegeneral medical examination at a healthcare facility, immunizations andscreening for infectious disease, other screening for suspectedconditions that are not mental disorders or infectious diseases, edema;abdominal pain at an unspecified site; another upper respiratorydisease, unspecified symptom associated with female genital organs, andchronic vascular insufficiency of the intestine.

In some embodiments of the invention, the feature category is proceduresand a feature is selected from the group consisting of: an office orother outpatient visit for the evaluation and management of anestablished patient, another laboratory procedure, an office or otheroutpatient visit for the evaluation and management of an establishedpatient, a chemistry and hematology laboratory procedure, anothertherapeutic procedure, a pathology procedure, another diagnosticradiology and related technique, a microscopic examination, an office orother outpatient visit for evaluation and management of an establishedpatient, and a nonoperative urinary system measurement.

In some embodiments of the invention, the feature category is therapiesand a feature is selected from the group consisting of: androgens andcombinations, blood derivatives, androgens and combinations, unspecifiedagents, sympathomimetic agents, adrenals and combinations, analgesics orantipyretics that are opiate agonists, antibiotics that are penicillins,antibiotics that are erythromycin and macrolide, and analgesics orantipyretics that are nonsteroidal anti-inflammatory drugs.

In some embodiments of the invention, the feature category is providersand a feature is selected from the group consisting of: an outpatienthospital, an office, an independent laboratory, an emergency department,an inpatient hospital, an independent clinic, a patient home, anoutpatient location that is not elsewhere classified, an ambulatorysurgical center; and a land ambulance.

In some embodiments of the invention, the one or more machine learningalgorithms comprise a linear Support Vector Machines classificationalgorithm.

In some embodiments of the invention, the one or more machine learningalgorithms comprise at least two machine learning algorithms and whereinthe tuning further comprises the one or more programs compiling resultsof the tuning of each of the at least two machine learning algorithmsand utilizing ensemble learning to consolidate portions of the at leasttwo machine learning algorithms into a single machine learningalgorithm.

In some embodiments of the invention, the tuning the one or moreprograms includes the one or more programs associating, based onapplying the one or more machine learning algorithms to the training setof test data, probabilities to a portion of the records in the trainingset of test data, wherein the probabilities reflect a likelihood ofpresence of the medical condition for each record training set of testdata. The one or more programs complete the dynamically adjusting of thecommon features when the probabilities are within a pre-defined accuracythreshold.

In some embodiments of the invention, the one or more programs determinethe probability by obtaining, from a computing resource, electronicmedical records for the undiagnosed patient for a defined temporalperiod, wherein the electronic medical records comprise electroniccontact information for a healthcare provider to the undiagnosedpatient. The one or more programs apply the one or more machine learningalgorithms to the electronic medical records. The one or more programsdetermine, based on the applying, if the probability is within apredetermined range. Based on determining that the probability exceeds apredetermined threshold, the one or more programs electronically alert,in real time, the healthcare provider to the undiagnosed patient of theprobability.

In some embodiments of the invention, the one or more programs retain,in a memory resource communicatively coupled to the one or moreprocessors, the one or more patterns. The one or more programs obtain anindication regarding accuracy of the probability. The one or moreprograms update the one or more patterns based on the indication.

FIG. 11 illustrates a block diagram of a resource 1300 in computersystem 110 and/or terminal 120 a-120 b, which is part of the technicalarchitecture of certain embodiments of the technique. The resource 1300may include a circuitry 370 that may in certain embodiments include amicroprocessor 354. The computer system 1300 may also include a memory355 (e.g., a volatile memory device), and storage 181. The storage 181may include a non-volatile memory device (e.g., EPROM, ROM, PROM, RAM,DRAM, SRAM, flash, firmware, programmable logic, etc.), magnetic diskdrive, optical disk drive, tape drive, etc. The storage 355 may comprisean internal storage device, an attached storage device and/or a networkaccessible storage device. The system 1300 may include a program logic330 including code 333 that may be loaded into the memory 355 andexecuted by the microprocessor 356 or circuitry 370.

In certain embodiments, the program logic 330 including code 333 may bestored in the storage 181, or memory 355. In certain other embodiments,the program logic 333 may be implemented in the circuitry 370.Therefore, while FIG. 2 shows the program logic 333 separately from theother elements, the program logic 333 may be implemented in the memory355 and/or the circuitry 370.

Using the processing resources of a resource 1300 to execute software,computer-readable code or instructions, does not limit where this codecan be stored.

Referring to FIG. 12, in one example, a computer program product 700includes, for instance, one or more non-transitory computer readablestorage media 702 to store computer readable program code means or logic704 thereon to provide and facilitate one or more aspects of thetechnique.

As will be appreciated by one skilled in the art, aspects of thetechnique may be embodied as a system, method or computer programproduct. Accordingly, aspects of the technique may take the form of anentirely hardware embodiment, an entirely software embodiment (includingfirmware, resident software, micro-code, etc.) or an embodimentcombining software and hardware aspects that may all generally bereferred to herein as a “circuit,” “module” or “system.” Furthermore,aspects of the technique may take the form of a computer program productembodied in one or more computer readable medium(s) having computerreadable program code embodied thereon.

Any combination of one or more computer readable medium(s) may beutilized. The computer readable medium may be a computer readable signalmedium or a computer readable storage medium. A computer readable signalmedium may include a propagated data signal with computer readableprogram code embodied therein, for example, in baseband or as part of acarrier wave. Such a propagated signal may take any of a variety offorms, including, but not limited to, electro-magnetic, optical or anysuitable combination thereof. A computer readable signal medium may beany computer readable medium that is not a computer readable storagemedium and that can communicate, propagate, or transport a program foruse by or in connection with an instruction execution system, apparatusor device.

A computer readable storage medium may be, for example, but not limitedto, an electronic, magnetic, optical, electromagnetic, infrared orsemiconductor system, apparatus, or device, or any suitable combinationof the foregoing. More specific examples (a non-exhaustive list) of thecomputer readable storage medium include the following: an electricalconnection having one or more wires, a portable computer diskette, ahard disk, a random access memory (RAM), a read-only memory (ROM), anerasable programmable read-only memory (EPROM or Flash memory), anoptical fiber, a portable compact disc read-only memory (CD-ROM), anoptical storage device, a magnetic storage device, or any suitablecombination of the foregoing. In the context of this document, acomputer readable storage medium may be any tangible medium that cancontain or store a program for use by or in connection with aninstruction execution system, apparatus, or device.

Program code embodied on a computer readable medium may be transmittedusing an appropriate medium, including but not limited to wireless,wireline, optical fiber cable, RF, etc., or any suitable combination ofthe foregoing.

Computer program code for carrying out operations for aspects of thetechnique may be written in any combination of one or more programminglanguages, including an object oriented programming language, such asJava, Smalltalk, Java, Python, R-Language, C++ or the like, andconventional procedural programming languages, such as the “C”programming language, assembler or similar programming languages. Theprogram code may execute entirely on the user's computer, partly on theuser's computer, as a stand-alone software package, partly on the user'scomputer and partly on a remote computer or entirely on the remotecomputer or server. In the latter scenario, the remote computer may beconnected to the user's computer through any type of network, includinga local area network (LAN) or a wide area network (WAN), or theconnection may be made to an external computer (for example, through theInternet using an Internet Service Provider).

Aspects of the technique are described herein with reference toflowchart illustrations and/or block diagrams of methods, apparatus(systems) and computer program products according to embodiments of theinvention. It will be understood that each block of the flowchartillustrations and/or block diagrams, and combinations of blocks in theflowchart illustrations and/or block diagrams, can be implemented bycomputer program instructions. These computer program instructions maybe provided to a processor of a general purpose computer, specialpurpose computer, or other programmable data processing apparatus toproduce a machine, such that the instructions, which execute via theprocessor of the computer or other programmable data processingapparatus, create means for implementing the functions/acts specified inthe flowchart and/or block diagram block or blocks.

These computer program instructions may also be stored in a computerreadable medium that can direct a computer, other programmable dataprocessing apparatus, or other devices to function in a particularmanner, such that the instructions stored in the computer readablemedium produce an article of manufacture including instructions whichimplement the function/act specified in the flowchart and/or blockdiagram block or blocks.

The computer program instructions, also referred to as computer programcode, may also be loaded onto a computer, other programmable dataprocessing apparatus, or other devices to cause a series of operationalsteps to be performed on the computer, other programmable apparatus orother devices to produce a computer implemented process such that theinstructions which execute on the computer or other programmableapparatus provide processes for implementing the functions/actsspecified in the flowchart and/or block diagram block or blocks.

In addition to the above, one or more aspects of the technique may beprovided, offered, deployed, managed, serviced, etc. by a serviceprovider who offers management of customer environments. For instance,the service provider can create, maintain, support, etc. computer codeand/or a computer infrastructure that performs one or more aspects ofthe technique for one or more customers. In return, the service providermay receive payment from the customer under a subscription and/or feeagreement, as examples. Additionally or alternatively, the serviceprovider may receive payment from the sale of advertising content to oneor more third parties.

In one aspect of the technique, an application may be deployed forperforming one or more aspects of the technique. As one example, thedeploying of an application comprises providing computer infrastructureoperable to perform one or more aspects of the technique.

As a further aspect of the technique, a computing infrastructure may bedeployed comprising integrating computer readable code into a computingsystem, in which the code in combination with the computing system iscapable of performing one or more aspects of the technique. As a furtheraspect of the technique, the system can operate in a peer to peer modewhere certain system resources, including but not limited to, one ormore databases, is/are shared, but the program code executable by one ormore processors is loaded locally on each computer (workstation).

As yet a further aspect of the technique, a process for integratingcomputing infrastructure comprising integrating computer readable codeinto a computer system may be provided. The computer system comprises acomputer readable medium, in which the computer medium comprises one ormore aspects of the technique. The code in combination with the computersystem is capable of performing one or more aspects of the technique.

Further, other types of computing environments can benefit from one ormore aspects of the technique. As an example, an environment may includean emulator (e.g., software or other emulation mechanisms), in which aparticular architecture (including, for instance, instruction execution,architected functions, such as address translation, and architectedregisters) or a subset thereof is emulated (e.g., on a native computersystem having a processor and memory). In such an environment, one ormore emulation functions of the emulator can implement one or moreaspects of the technique, even though a computer executing the emulatormay have a different architecture than the capabilities being emulated.As one example, in emulation mode, the specific instruction or operationbeing emulated is decoded, and an appropriate emulation function isbuilt to implement the individual instruction or operation.

In an emulation environment, a host computer includes, for instance, amemory to store instructions and data; an instruction fetch unit tofetch instructions from memory and to optionally, provide localbuffering for the fetched instruction; an instruction decode unit toreceive the fetched instructions and to determine the type ofinstructions that have been fetched; and an instruction execution unitto execute the instructions. Execution may include loading data into aregister from memory; storing data back to memory from a register; orperforming some type of arithmetic or logical operation, as determinedby the decode unit. In one example, each unit is implemented insoftware. For instance, the operations being performed by the units areimplemented as one or more subroutines within emulator software.

Further, a data processing system suitable for storing and/or executingprogram code is usable that includes at least one processor coupleddirectly or indirectly to memory elements through a system bus. Thememory elements include, for instance, local memory employed duringactual execution of the program code, bulk storage, and cache memorywhich provide temporary storage of at least some program code in orderto reduce the number of times code must be retrieved from bulk storageduring execution.

Input/Output or I/O devices (including, but not limited to, keyboards,displays, pointing devices, DASD, tape, CDs, DVDs, thumb drives andother memory media, etc.) can be coupled to the system either directlyor through intervening I/O controllers. Network adapters may also becoupled to the system to enable the data processing system to becomecoupled to other data processing systems or remote printers or storagedevices through intervening private or public networks. Modems, cablemodems, and Ethernet cards are just a few of the available types ofnetwork adapters.

Embodiments of the present invention may be implemented in cloudcomputing systems. FIG. 6 may also comprise a node in this type ofcomputing environment.

The terminology used herein is for the purpose of describing particularembodiments only and is not intended to be limiting of the invention. Asused herein, the singular forms “a”, “an” and “the” are intended toinclude the plural forms as well, unless the context clearly indicatesotherwise. It will be further understood that the terms “comprises”and/or “comprising”, when used in this specification, specify thepresence of stated features, integers, steps, operations, elements,and/or components, but do not preclude the presence or addition of oneor more other features, integers, steps, operations, elements,components and/or groups thereof.

The corresponding structures, materials, acts, and equivalents of allmeans or step plus function elements in the descriptions below, if any,are intended to include any structure, material, or act for performingthe function in combination with other elements as specifically noted.The description of the technique has been presented for purposes ofillustration and description, but is not intended to be exhaustive orlimited to the invention in the form disclosed. Many modifications andvariations will be apparent to those of ordinary skill in the artwithout departing from the scope and spirit of the invention. Theembodiment was chosen and described in order to best explain theprinciples of the invention and the practical application, and to enableothers of ordinary skill in the art to understand the invention forvarious embodiments with various modifications as are suited to theparticular use contemplated.

What is claimed is:
 1. A computer-implemented method, comprising:obtaining, by one or more processors in a distributed computingenvironment, one or more machine-readable data sets related to a patientpopulation from one or more databases; identifying, by the one or moreprocessors, based on an initial patient definition, a portion of datafrom the machine-readable data sets related to a patient population,wherein the portion of the data comprises patients of the patientpopulation with a medical condition; based on a frequency of features inthe portion of the data, identifying, by the one or more processors,common features in the portion of the data and weighting the commonfeatures based on frequency of occurrence in the portion of the data,wherein the common features comprise mutual information; generating, bythe one or more processors, one or more patterns comprising a portion ofthe common features; generating, by the one or more processors, one ormore machine learning algorithms based on the one or more patterns, theone or more machine learning algorithms to identify presence or absenceof the given medical condition in an undiagnosed patient based onabsence or presence of features comprising the one or more patterns indata related to the undiagnosed patient; utilizing, by the one or moreprocessors, statistical sampling to compile a training set of data,wherein the training set comprises data from the one or more data setsand at least one additional data set comprising data related to apopulation without the medical condition, and wherein utilizing thestatistical sampling comprises formulating and obtaining queries basedon the data set and processing and responding to the queries, theprocessing comprising, for each query: evaluating, by the one or moreprocessors, the query to determine one of a high or a low level ofanticipated complexity of a prospective response to the query; based onthe query being evaluated at a low level of anticipated complexity,assigning, by the one or more processors, the query to a computingresource in the distributed computing environment, wherein the computingresource is configured to respond to low level complexity queries; andbased on the query being evaluated at a high level of anticipatedcomplexity, distributing, by the one or more processors, the query overa group of computing resources of the distributed computing environmentto maximize efficiency, wherein the distributing comprises assigningeach computing resource of the group of computing resources a portion ofthe query to execute in parallel with at least one other computingresource of the group of computing resources executing another portionof the query; tuning, by the one or more processors, the one or moremachine learning algorithms by applying the one or more machine learningalgorithms to the training set of data; dynamically adjusting, by theone or more processors, the common features comprising the one or morepatterns to improve accuracy such that the one or more machine learningalgorithms can distinguish patient data indicating the medical conditionfrom patient data that does not indicate the medical condition; anddetermining, by the one or more processors, based on applying the one ormore machine learning algorithms to data related to the undiagnosedpatient, a probability, wherein the probability is a numerical valueindicating a percentage of commonality between the data related to theundiagnosed patient and the one or more patterns.
 2. The method of claim1, wherein the initial patient definition is selected from the groupconsisting of: a pre-defined diagnosis code and a pre-definedmedication.
 3. The method of claim 2, wherein the pre-defined medicationis selected from the group consisting of: Cinryze, Firazyr, Berinert,and Kalbitor, and wherein the probability indicates a probability thatthe undiagnosed patient has the medical condition.
 4. The method ofclaim 1, wherein the one or more machine-readable data sets comprise thedata related to the undiagnosed patient.
 5. The method of claim 4,further comprising: determining, by the one or more processors, based onapplying the one or more machine learning algorithms to data related toeach patient not included in the portion of the data, for each patient,a respective probability, wherein the respective probability is anumerical value indicating the percentage of commonality between thedata related to the undiagnosed patient and the one or more patterns. 6.The method of claim 5, further comprising: ranking, by the one or moreprocessors, the probability and the respective probabilities, in orderof relevance; and notifying, by the one or more processors, through anelectronic communication, a user of an identity of any patient in theone or more machine-readable data sets with a probability above apredetermined threshold; and automatically ordering, by the one or moreprocessors, based on communicating with an order management system overa network connection, a clinical test for the medical condition, whereina number of tests ordered is directly proportional to a number ofpatients with the probability above the predetermined threshold
 7. Themethod of claim 1, wherein the generating the one or more patternscomprises: ranking, by the one or more processors, the common featuresbased on the weighting; and retaining, by the one or more processors,the portion of the common features wherein the portion comprises commonfeatures of a pre-defined weight, wherein the portion comprises the oneor more patterns.
 8. The method of claim 1, wherein the mutualinformation comprises features from a plurality of feature categoriesand wherein each pattern of the one or more patterns comprising aportion of the common features comprises features in one featurecategory of the plurality of feature categories.
 9. The method of claim8, wherein the medical condition is Hereditary Angioedema, and whereinthe one feature category is selected from the group consisting of:diagnosis codes, procedures, therapies, providers, and locations. 10.The method of claim 9, wherein the feature category is diagnosis codesand one of the features is selected from the group consisting of: anallergic reaction, a swelling, mass, or lump in head and neck, a routinegeneral medical examination at a healthcare facility, an immunizationand screening for an infectious disease, another screening for suspectedconditions that are not mental disorders or infectious diseases, anedema, an abdominal pain at an unspecified site, another upperrespiratory disease, an unspecified symptom associated with femalegenital organs, and a chronic vascular insufficiency of the intestine.11. The method of claim 9, wherein the feature category is proceduresand one of the features is selected from the group consisting of: anoffice or other outpatient visit for the evaluation and management of anestablished patient, another laboratory procedure, an office or otheroutpatient visit for the evaluation and management of an establishedpatient, a chemistry and hematology laboratory procedure, anothertherapeutic procedure, a pathology procedure, another diagnosticradiology and related technique, a microscopic examination, an office orother outpatient visit for evaluation and management of an establishedpatient, and a nonoperative urinary system measurement.
 12. The methodof claim 9, wherein the feature category is therapies and one of thefeatures is selected from the group consisting of: androgens andcombinations, blood derivatives, androgens and combinations, unspecifiedagents, sympathomimetic agents, adrenals and combinations, analgesics orantipyretics that are opiate agonists, antibiotics that are penicillins,antibiotics that are erythromycin and macrolide, and analgesics orantipyretics that are nonsteroidal anti-inflammatory drugs.
 13. Themethod of claim 9, wherein the feature category is providers and one ofthe features is selected from the group consisting of: an outpatienthospital, an office, an independent laboratory, an emergency department,an inpatient hospital, an independent clinic, a patient home, anoutpatient location that is not elsewhere classified, an ambulatorysurgical center; and a land ambulance.
 14. The method of claim 1,wherein the one or more machine learning algorithms comprise a linearSupport Vector Machines classification algorithm.
 15. The method ofclaim 1, wherein the one or more machine learning algorithms comprise atleast two machine learning algorithms and wherein the tuning furthercomprises: compiling results of the tuning of each of the at least twomachine learning algorithms and utilizing ensemble learning toconsolidate portions of the at least two machine learning algorithmsinto a single machine learning algorithm.
 16. The method of claim 1, thetuning further comprising: associating, by the one or more processors,based on applying the one or more machine learning algorithms to thetraining set of test data, probabilities to a portion of the records inthe training set of test data, wherein the probabilities reflect alikelihood of presence of the medical condition for each record trainingset of test data; and completing the dynamically adjusting of the commonfeatures when the probabilities are within a pre-defined accuracythreshold.
 17. The method of claim 1, wherein the determining theprobability comprises: obtaining, by the one or more processors, from acomputing resource, electronic medical records for the undiagnosedpatient for a defined temporal period, wherein the electronic medicalrecords comprise electronic contact information for a healthcareprovider to the undiagnosed patient; applying, by the one or moreprocessors, the one or more machine learning algorithms to theelectronic medical records; determining, by the one or more processors,based on the applying, if the probability is within a predeterminedrange; and based on determining that the probability exceeds apredetermined threshold, electronically alerting, in real time, thehealthcare provider to the undiagnosed patient of the probability. 18.The method of claim 17, further comprising: retaining, by the one ormore processors, in a memory resource communicatively coupled to the oneor more processors, the one or more patterns; obtaining, by the one ormore processors, an indication regarding accuracy of the probability;and updating, by the one or more processors, the one or more patternsbased on the indication.
 19. A computer program product comprising: acomputer readable storage medium readable by one or more processors in adistributed computing environment, and storing instructions forexecution by the one or more processors for performing a methodcomprising: obtaining, by the one or more processors in a distributedcomputing environment, one or more machine-readable data sets related toa patient population from one or more databases; identifying, by the oneor more processors, based on an initial patient definition, a portion ofdata from the machine-readable data sets related to a patientpopulation, wherein the portion of the data comprises patients of thepatient population with a medical condition; based on a frequency offeatures in the portion of the data, identifying, by the one or moreprocessors, common features in the portion of the data and weighting thecommon features based on frequency of occurrence in the portion of thedata, wherein the common features comprise mutual information;generating, by the one or more processors, one or more patternscomprising a portion of the common features; generating, by the one ormore processors, one or more machine learning algorithms based on theone or more patterns, the one or more machine learning algorithms toidentify presence or absence of the given medical condition in anundiagnosed patient based on absence or presence of features comprisingthe one or more patterns in data related to the undiagnosed patient;utilizing, by the one or more processors, statistical sampling tocompile a training set of data, wherein the training set comprises datafrom the one or more data sets and at least one additional data setcomprising data related to a population without the medical condition,and wherein utilizing the statistical sampling comprises formulating andobtaining queries based on the data set and processing and responding tothe queries, the processing comprising, for each query: evaluating, bythe one or more processors, the query to determine one of a high or alow level of anticipated complexity of a prospective response to thequery; based on the query being evaluated at a low level of anticipatedcomplexity, assigning, by the one or more processors, the query to acomputing resource in the distributed computing environment, wherein thecomputing resource is configured to respond to low level complexityqueries; and based on the query being evaluated at a high level ofanticipated complexity, distributing, by the one or more processors, thequery over a group of computing resources of the distributed computingenvironment to maximize efficiency, wherein the distributing comprisesassigning each computing resource of the group of computing resources aportion of the query to execute in parallel with at least one othercomputing resource of the group of computing resources executing anotherportion of the query; tuning, by the one or more processors, the one ormore machine learning algorithms by applying the one or more machinelearning algorithms to the training set of data; dynamically adjusting,by the one or more processors, the common features comprising the one ormore patterns to improve accuracy such that the one or more machinelearning algorithms can distinguish patient data indicating the medicalcondition from patient data that does not indicate the medicalcondition; and determining, by the one or more processors, based onapplying the one or more machine learning algorithms to data related tothe undiagnosed patient, a probability, wherein the probability is anumerical value indicating a percentage of commonality between the datarelated to the undiagnosed patient and the one or more patterns.
 20. Asystem comprising: one or more memory; one or more processors incommunication with the memory; and program instructions executable bythe one or more processors in a distributed computed environment via theone or more memory to perform a method, the method comprising:obtaining, by the one or more processors in a distributed computingenvironment, one or more machine-readable data sets related to a patientpopulation from one or more databases; identifying, by the one or moreprocessors, based on an initial patient definition, a portion of datafrom the machine-readable data sets related to a patient population,wherein the portion of the data comprises patients of the patientpopulation with a medical condition; based on a frequency of features inthe portion of the data, identifying, by the one or more processors,common features in the portion of the data and weighting the commonfeatures based on frequency of occurrence in the portion of the data,wherein the common features comprise mutual information; generating, bythe one or more processors, one or more patterns comprising a portion ofthe common features; generating, by the one or more processors, one ormore machine learning algorithms based on the one or more patterns, theone or more machine learning algorithms to identify presence or absenceof the given medical condition in an undiagnosed patient based onabsence or presence of features comprising the one or more patterns indata related to the undiagnosed patient; utilizing, by the one or moreprocessors, statistical sampling to compile a training set of data,wherein the training set comprises data from the one or more data setsand at least one additional data set comprising data related to apopulation without the medical condition, and wherein utilizing thestatistical sampling comprises formulating and obtaining queries basedon the data set and processing and responding to the queries, theprocessing comprising, for each query: evaluating, by the one or moreprocessors, the query to determine one of a high or a low level ofanticipated complexity of a prospective response to the query; based onthe query being evaluated at a low level of anticipated complexity,assigning, by the one or more processors, the query to a computingresource in the distributed computing environment, wherein the computingresource is configured to respond to low level complexity queries; andbased on the query being evaluated at a high level of anticipatedcomplexity, distributing, by the one or more processors, the query overa group of computing resources of the distributed computing environmentto maximize efficiency, wherein the distributing comprises assigningeach computing resource of the group of computing resources a portion ofthe query to execute in parallel with at least one other computingresource of the group of computing resources executing another portionof the query; tuning, by the one or more processors, the one or moremachine learning algorithms by applying the one or more machine learningalgorithms to the training set of data; dynamically adjusting, by theone or more processors, the common features comprising the one or morepatterns to improve accuracy such that the one or more machine learningalgorithms can distinguish patient data indicating the medical conditionfrom patient data that does not indicate the medical condition; anddetermining, by the one or more processors, based on applying the one ormore machine learning algorithms to data related to the undiagnosedpatient, a probability, wherein the probability is a numerical valueindicating a percentage of commonality between the data related to theundiagnosed patient and the one or more patterns.